Memorandum by the Foundation Trust Network
(FTM 04)
FOUNDATION TRUSTS
FOUNDATION TRUST
ACHIEVEMENTS
Since their establishment foundation trusts
have become leaders in the NHS for financial performance, quality,
innovation, local accountability and staff engagement. Set out
below is an overview of what the foundation trust sector has achieved
over the past four years.
— Growing the sector: In April
2004 there were just 10 foundation trusts. By the end of June
2008 the sector will have grown to 100 authorised foundation trusts.
This constitutes substantial and consistent growth of this new
sector within the system.
— Finances: Foundation trusts
continue to be strong performers financially. As Monitor recently
reported the sector's revenues were £566 million ahead of
plan, and the net surplus stood at £514 million. Cash balances
amounted to £2.3 billion. Foundation trusts are reinvesting
these surpluses to improve the patient experience—by upgrading
their existing estate, new build or service improvements. For
example:
— South Essex Partnership Trust reinvested
its surplus to build and open a brand new mental health hospital
at Rochford and a six bed psychology unit for young people.
— Aintree Foundation Trust has set
significant money aside this year for investment in clinical services:
£2.2 million to improve nurse staffing level on wards and
plans for £2.1 million going into radiology.
Foundation trust boards of governors play a
key role in influencing each foundation trust's strategy and its
high level investment plans.
— Quality: The results of this
year's Annual Healthcheck demonstrate the progress that foundation
trusts are making on the quality of services they deliver:
— Nineteen trusts were scored "excellent"
for quality of service and "excellent" for use of resources—all
19 were foundation trusts.
— Eighty per cent of all foundation
trusts scored "excellent" or "good" for quality
of service. Our analysis of these results also shows the performance
transformation that can take place during the foundation trust
authorisation process.
— Of the 20 foundation trusts authorised
in 2006, nine showed an improvement in both quality and resources
scores, and 18 showed an improvement in one of these scores on
their 2005-06 results (pre-authorisation).
— Staff satisfaction: Foundation
trusts are making a real impact on staff satisfaction levels.
The results of the 2007 NHS staff survey showed that on measures
of the extent of positive feeling within the organisation, eight
out of ten of the top performers are foundation trusts and of
all the trusts scoring above average 50% of them are FTs. This
picture is repeated on job satisfaction measures with FTs making
up 40% of all trusts above average, and within that 13 out of
20 top performers are foundation trusts.
This year's survey results show similar positive
results for foundation trusts. In response to the statement "care
of patients or service users is my trust's top priority",
55% of those working in acute foundation trusts agreed or strongly
agreed, compared to 44% in non-foundation trusts. In response
to the statement "senior managers try to involve staff in
important decisions" 24% of those working in acute foundation
trusts agreed or strongly agreed, compared to 21% in non-foundation
trusts. This difference was more sharply defined in specialist
FTs where 31% agreed or strongly agreed, compared to 25% in non-FT
specialist trusts.
— Innovation: foundation trusts
are able to pioneer new approaches and use their freedoms to innovate
to improve services for the patients in their trusts and the wider
NHS, and, on occasions, make advances in medical technology. Set
out below are two examples of this:
Gloucestershire Hospitals NHS Foundation Trust
has pulled off a national first in a partnership deal with
a local charity, Hope for Tomorrow, to provide a mobile chemotherapy
team across three counties where many residents live in isolated
communities. The foundation trust was free to make the decision
when the charity approached it—proving that good ideas can
happen quickly in an FT. In Gloucestershire chemotherapy was provided
in a secondary setting, and the FT wanted to push out the service
so that a safe, quality assured infection free service could get
to where the patients were. The FT wanted to cover all three counties—not
just their own. This innovation was about looking at the way the
FT provided services from the standpoint of the patient and then
finding ways to do things differently. And the FT had the financial
freedom to deliver part of the cost without referral to other
bodies.
Salisbury NHS Foundation Trust "spin
off" company—Odstock Medical Limited makes and
market electronic devices that help disabled patients to walk
by stimulating paralysed muscles. OML is the first "spin
off" company to be created and owned by the NHS. Salisbury
NHS FT has taken the innovative route of creating their own company
so that the income generated by the device can be used to further
research and create new developments to help NHS patients. Salisbury
maintains majority ownership of the company—68%—with
the hospital charity owning 18%. The only other shareholders are
staff and Bournemouth University. As the FT has the majority share
it can ensure that the philosophy of the company remains dedicated
to putting patient care first. Salisbury has used the financial
flexibility afforded by FT status to grow the company and has
renovated the hospital's old burns unit to house it. Its medical
physics department has been developing and producing the devices
for 20 years. However until now operating constraints within the
NHS severely limited their availability to patients outside the
Salisbury area.
LOCAL ACCOUNTABILITY
AND MEMBERSHIP
With close to a million members and over 2,000
governors, foundation trusts are taking the NHS into a new era
of local accountability and engagement. The level of membership
in FTs is greater than the membership of the three political parties
combined. The government is pushing for three million members
by 2010. The FTN is supporting this push—and at the same
time focusing on building foundation trust accountabilities by
ensuring that memberships are diverse, and representative of the
communities and groups they serve.
Although the governance arrangements in foundation
trusts are new, and are taking time to establish themselves, it
is clear that they offer enhanced responsiveness to and engagement
with local communities, patients and service users. The governance
model, involving members and governors, means there is now an
independent voice at every level to emphasise the views of the
patient and carer. These quotes from a foundation trust chair,
chief executive, and governor, underline this:
— "It is partly a recognition
of the Governors' perceptions that our priorities for next year
are patient safety, the patient experience and underpinning information
systems". Dr Mary Archer, Chair of Cambridge University Hospitals
NHS Foundation Trust.
— "We are much more focused on
what the public are looking for. We now have vehicle for talking
directly to the public, whom we serve". Angela Pedder, Chief
Executive of Royal Devon and Exeter NHS Foundation Trust.
— "As governors on the high quality
patient care group we have really championed the quality agenda
and the need for the Trust to both listen to and learn from patients".
Veronica Beechey patient governor at University College London
Hospitals NHS Foundation Trust.
Part of the FTN's recent survey of governors
demonstrates how governors are engaged in shaping the future strategy
of foundation trusts, and holding the trust to account through
its challenge role. The survey had a response rate of 67%, and
of these:
— 89% of governors said they were both
involved in the FT's strategy and working on the business plan.
— 89% saw their role as making the
foundation trust more patient focused.
— 85% saw their role as influencing
FT policies and priorities.
— 63% saw it as challenging policy
decisions of the board.
— 83% feel involved in the strategic
decisions of the board.
— 91% saw their role as recruiting
members.
— 76% saw their role as devising member
engagement programmes.
The results of this survey mirror the results
of the survey of foundation trust governors carried out by Monitor.
ABOUT THE
FTN
The FTN is the voice of foundation trusts. We
were established four years ago to represent authorised foundation
trusts as well as those trusts preparing for foundation trust
status. We currently have 180 members, and that number is growing
all the time. Our membership includes 96% of authorised foundation
trusts (both acute and mental health), as well as 84 aspirant
trusts in a range of sectors—acute, mental health, ambulance
trusts, NHS Direct and most recently aspirant community foundation
trusts.
Our aim is to improve the system for patients,
services users and staff by raising the profile of the issues
facing existing and aspirant foundation trusts and strengthening
the influence of FTN members. The FTN has an independent board
elected by our members, made up of chairs and chief executives
of foundation trusts.
Our work programme is organised around three
priority areas:
— Representing views—as the national
voice for foundation trusts, we provide the point of contact for
those wanting to know more about the foundation trust movement.
— Shaping policy—our policy agenda
focuses not just on the immediate issues facing foundation trusts
but on the changes needed to ensure the success of wider NHS reforms.
— Sharing learning—part of our
mission is to enable foundation trusts to share innovation and
learning within the FT movement and across the health services.
Alongside this we also run a preparation programme,
funded by the Department of Health, to help NHS organisations
prepare for foundation trust status.
As this brief overview has shown, foundation
trusts are taking the NHS in a new direction—in terms of
financial performance, quality, innovation, local accountability
and staff engagement. As the representative voice of foundation
trusts, the Foundation Trust Network is in a position to provide
an accurate insight into the progress of the whole sector, the
learning undertaken and the challenges ahead.
June 2008
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